title: Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic eventration.
abstract: OBJECTIVE
  Diaphragmatic plication by minimally invasive surgery is thought to allow for a quick recovery and has been performed on small children. Here, we report our experience with different plication procedures to discuss how to choose among these different plication procedures in endoscopic surgery for pediatric patients with diaphragmatic eventration.
  
  
  METHODS
  We retrospectively analyzed clinical data of 27 pediatric patients (21 boys, 6 girls; median age: 12.7 months, range 2 months-3 years) admitted to our hospital between November 2008 and July 2013. Three different plication procedures were used: the "reefing the mainsail" technique (8 patients), "invaginating the diaphragmatic dome" technique (10 patients), and "pleating" technique (9 patients). Indications included ventilator dependency (7.41 %), respiratory distress (22.22 %), chronic lung lobe collapse (11.11 %), persistent atelectasis with recurrent pneumonias (18.52 %), and asymptomatic severe eventration (40.74 %).
  
  
  RESULTS
  Descending distance of diaphragm after surgery ranged from 1 to 4.5 intercostal spaces (mean distance: 2.65 intercostal spaces). All patients recovered well postoperatively, except for one patient with a pneumothorax. Two patients who required respiratory support before the operation no longer required it within 7 d after surgery. Follow-up ranged from 1 to 35 months. Clinical results were satisfactory with obvious improvement in symptoms and a slight re-elevation within a distance of one intercostal space.
  
  
  CONCLUSIONS
  For pediatric patients with diaphragmatic eventration, different endoscopic surgeries and plication procedures all yielded satisfactory results. We believe that the choice of one procedure over the other depends only on the surgeon's experience.
authors.affiliation: Department of Pediatric Surgery, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No 1665, Kongjiang Road, Shanghai, 200092, People's Republic of China, jimeng1214@126.com.
authors.forename: Jimeng
authors.initials: J
authors.lastname: Hu
authors.forename: Yeming
authors.initials: Y
authors.lastname: Wu
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.forename: Weihua
authors.initials: W
authors.lastname: Pan
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D002675:Child, Preschool; D003964:Diaphragm / Q000601:surgery*; D003965:Diaphragmatic Eventration / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome